Dec. 28, 2016. Japanese Journal of Clinical Psychiatry no.45 (special issue) pp.312-315, written by Satoshi Tanaka and Norio Ozaki. “Hospitalization and Physical Management for Anorexia Nervosa”
神経性やせ症の事例は、適切な病識・治療動機を伴わないまま受診に至ることも多い。本人の思考は著しい頑なさを見せるが、本人の動機付けを最重視するアプローチが従来から推奨されており、通常はそれが原則となる。しかし、例えばBMI ; Body Mass Indexが10前後以下となるなどの身体医学的重症例においては、動機付けを優先する待期的アプローチでは救命すら難しくなることがある。
In cases of anorexia nervosa (AN), they often visit medical consultation without appropriate insight into disease (the recognition that he/she is sick) or treatment motivation. Although their thoughts show remarkable stubbornness, approaches that emphasize to grow their motivation toward treatment has been recommended from the past, and usually this is the principle of the treatment of AN. However, in cases of severe physical condition such as Body Mass Index (BMI) being about 10 or less, approaches that prioritize motivation may fail to save their lives.
This paper focuses on the introduction of involuntary hospitalization for cases with severe physical condition due to AN, which has been rarely described so far.
During intake interview, medical histories are often difficult to take from the patient himself/herself, often depending on information from family members. The intake would focus on whether they have social activities and hobby activities and the problems occurring in their daily activities. Asking the most recent daily caloric intake is important to decide the amount of their daily nourishment.
Clarify that the most important and immediate treatment target is not to treat the symptoms of AN but to save their lives.
As a psychiatric primary evaluation, apart from physical evaluation, pay attention to the patients’ acceptance of treatment and their psychiatric comorbidities. Precise diagnosis (e.g. subtypes of AN) can only be performed roughly at this point.
Key point of explanation; "You are under a critical condition on the edge of death due to mal-nutrition, and it is necessary to start physical treatment promptly to save your life". When the patient lacks the recognition that he/she is sick, we explain that it is difficult for himself/herself to recognize the critical condition due to the deterioration of brain function.